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Clinical Evaluation of the Shoulder Shrug Sign

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Clinical Orthopaedics and Related Research

Abstract

The “shrug sign” (inability to lift the arm to 90° abduction without elevating the whole scapula or shoulder girdle) has been associated with a diagnosis of rotator cuff disease. Based on our clinical experience, we hypothesized the shrug sign is not a specific diagnostic sign for this condition, but rather is associated with various shoulder conditions and shoulder weakness and loss of range of motion. We retrospectively reviewed 982 consecutive patients who had been examined preoperatively for the shrug sign. A positive shrug sign was present in 51.3% of the patients, and the average distance lost from the horizontal was 20.5° ± 2.2° (standard error of mean). Increasing age was associated with the presence of a shrug sign. The highest incidence was in patients with adhesive capsulitis (94.7%). The shrug sign was not sensitive for tendinosis, partial rotator cuff tears, or full-thickness or massive rotator cuff tears. The shrug sign was associated with weakness in abduction, night pain, and loss of range of motion, especially passive abduction. Although the shrug sign is useful as a general sign of shoulder abnormality, particularly when associated with stiffness, it was not specific or sensitive for rotator cuff problems.

Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Division of Shoulder Surgery, Department of Orthopaedic Surgery, c/o Elaine P. Henze, BJ, ELS, Medical Editor, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, 4940 Eastern Ave., #A672, Baltimore, MD, 21224, USA

    Xiaofeng Jia MD, PhD, Jong-Hun Ji MD, Steve A. Petersen MD, Jennifer Keefer PA-C & Edward G. McFarland MD

Authors
  1. Xiaofeng Jia MD, PhD
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  2. Jong-Hun Ji MD
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  3. Steve A. Petersen MD
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  4. Jennifer Keefer PA-C
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  5. Edward G. McFarland MD
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Corresponding author

Correspondence to Edward G. McFarland MD.

Additional information

The authors have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. There were no funding sources for this work.

This study was exempt from IRB approval.

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Jia, X., Ji, JH., Petersen, S.A. et al. Clinical Evaluation of the Shoulder Shrug Sign. Clin Orthop Relat Res 466, 2813–2819 (2008). https://doi.org/10.1007/s11999-008-0331-3

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  • DOI: https://doi.org/10.1007/s11999-008-0331-3

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